The following guest article comes from Care Resources, a community-based program that helps older adults in West Michigan remain in their homes.
Nancy Baker and Barbara Scothorn share a single mission as nurses: keeping seniors out of hospitals and nursing homes.
That mission is at the heart of their employer’s approach to health care. Both work for Care Resources, an innovative community-based program for people 55 years and older that promotes healthy and independent living for residents of Kent County and portions of Allegan, Barry, Ionia and Ottawa counties.
“We always know the nurse’s primary role is education,” explained Baker, who serves as clinic and day center manager for Care Resources. “Often a provider can be talking to a participant, but it’s really the nurse who can help them understand how to manage their diabetes or COPD.”
Scothorn agreed, adding: “Nurses are there to work with a participant and help them meet their goal, which is staying in their home and out of the hospital. It’s a partnership. We work with participants and their families to provide wrap-around services that supplement what they are able to do. Families play a huge role, and we take them into consideration in our planning.”
Scothorn serves as manager of home care and intake enrollment for Care Resources, which is a Program of All-inclusive Care for the Elderly, or PACE®. Funded by Medicare and Medicaid, PACE services require no out-of-pocket payments for those who meet income requirements.
Care Resources offers a day center, clinic and pharmacy in its 36,000-square-foot facility in Grand Rapids that deliver a wide range of health care services as well as opportunities that promote socialization, build community and offer respite to caregivers. The nonprofit also provides home health services, including family and caregiver support, home care services and rehab and durable medical equipment, such as walkers, wheelchairs, oxygen and diabetic testing supplies.
All of this support, Baker and Scothorn know, is critical in keeping participants safe at home. They listed a host of reasons why people 55 years and older often wind up needing acute medical care:
- Worsening medical conditions that go unnoticed when loved ones aren’t around.
- Poorly managed medication, including skipped or doubled doses.
- Unobserved changes to breathing, blood pressure or weight that signal larger health issues.
- Poor nutrition and dehydration, which can cause a cascade of other health issues.
- Social isolation, which can lead to rapid or steady decline in physical and mental health.
“My nurses in the clinic are great on triage and assessment,” Baker said. “They complement the work of Barb’s nurses and home health aides, who play a vital role in seeing what patients go through every day and addressing issues before they become problems.”
Baker and Scothorn highlight simple things loved ones can do to ensure older adults can be safe at home, including:
- Ongoing education to help better manage chronic conditions, such as diabetes, or disease progression for illnesses such as Alzheimer’s and heart failure.
- Medication assistance, such as setting up pills in a med box or med wheel so it’s easier to keep track of daily doses.
- Home safety checks, such as removing throw rugs to prevent falls and installing grab bars instead of towel racks.
- Meal preparation, such as stocking their freezers with meals they like and to improve their nutrition.
- Transportation support to ensure they can get to their medical and other appointments.
- Social support and a safe place to go during the day, such as the Care Resources day center, for stimulation and engagement – and to give caregivers a needed break.
“These are great steps to help older adults stay healthy and remain in their homes,” Scothorn said. “Nurses can provide an additional layer of support. We are often the first to notice changes and issues – we’re trained to watch and take action to help community members age safely in place.”
For more information on Care Resources, visit CareResources.org.
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